Background: inflammatory bowel disease (IBD) comprises Crohn’s Disease and ulcerative colitis, which are chronic disorders characterized by inflammation of the gastrointestinal (GI) tract. IBD mainly occurs after the second decade of life. IBD is known to be caused by a combination of genetic and environmental factors and a dysregulated immune system. While ulcerative colitis comprises a diffuse mucosal inflammation of the large bowel, Crohn’s disease presents as a patchy and transmural inflammation anywhere in the GI tract. The severity of IBD varies over time and urgent medical care is required when complications arise. Thus, clinical practice guidelines (CPGs) for IBD diagnosis and treatment have been created and updated over time. To our knowledge, only one study has assessed CPGs' quality for IBD, all of which were published in Japanese. The aim of this revision is to evaluate current CPGs for IBD diagnosis and treatment so that healthcare professionals and patients can benefit from it.
Objectives: to systematically review CPGs focused on IBD diagnosis and treatment, and to assess the:
1) methodological quality using the AGREE II tool (Appraisal of Guidelines for Research and Evaluation);
2) changes in quality over time; and
3) consistency of clinical recommendations.
Methods: we performed a systematic search in databases and CPGs developers' websites including MEDLINE, Embase, CINAHL, LILACS, NICE, SIGN, ACG, AGA, Portuguese Gastroenterology Society, and Australian Gastroenterology Society. Two reviewers (DH,CM) were calibrated for the inclusion of CPGs by screening the same 25% of total records by title and abstract (Tiab), the intraclass correlation coefficient (ICC) between reviewers was 0.7. The remaining 75% of total records was divided between the two reviewers, who assessed them independently. A similar process was performed for full-text assessment obtaining an ICC of 0.8. If reviewers disagreed, a third reviewer (AV) was involved and conflicts were solved by discussion. The included CPGs will be evaluated by all authors using the AGREE II tool.
Preliminary results: we retrieved a total of 5134 records, and 5042 remained after de-duplication. We included 110 records after Tiab screening for full-text assessment, and included 23 CPGs for data extraction (Figure 1). We have obtained data from 14 of the 23 included CPGs; these were published in English, Spanish, Japanese, German and Korean. Six CPGs focused on ulcerative colitis, four focused on Crohn's diseases, and four addressed IBD in general. Moreover, the 14 CPGs were developed in Israel (4), Germany (1), Japan (2), Mexico (2), Canada (1), the USA (2), South Korea (1) and the UK (1). CPGs developers include: professional associations or societies (9), universities (3), governments (1), and international organizations (1).
Conclusions: this evaluation of 23 up-to-date CPGs for the diagnosis and treatment of IBD contributes to a better understanding of the quality of evidence-based clinical recommendations.
Patient involvement: not applicable